Snoring and obstructive sleep apnoea (OSA)

Written by Dr Gavin W Petrie, consultant chest physician

How does the doctor make a diagnosis?
The doctor will listen to a description of the symptoms which are typically as follows:

snoring

breaks in breathing during the night

sleepiness during the day.

The nasal passage and the upper respiratory tract should be examined to exclude the possibility of swelling within the nose or oropharynx, deviated nasal septum or tumour.

The sleeping pattern can be assessed either in the hospital or at home by using monitoring equipment. This is to measure the blood oxygen level and register snoring sounds, the movement of air through the nose and mouth and chest movement. Sometimes the depth of sleep may also be measured, along with movement of the legs and blood carbon dioxide level.

Other possible causes for sleepiness during the day will be eliminated by a general physical examination.

Future prospects
If you lose weight, there is a good chance of the symptoms disappearing. Otherwise the disease will seldom go away by itself.

How is snoring and OSA treated?
OSA is best treated with a device called a CPAP machine, so called because it blows a gentle stream of air through the nose at night producing a 'constant positive airway pressure'. This keeps the pressure in the throat higher than the atmospheric pressure so that the throat is not pressed closed. Many sufferers say this works so well at preventing breathing pauses and snoring that they are no longer sleepy during the day.

However, CPAP therapy does not actually cure the problem and the patient should still make an effort to lose weight. A specially moulded plastic mouth insert (orthodontic prosthesis) to hold the jaw forwards can help individuals with short jaws who snore.

There are no medicines of proven value in the treatment of this condition.

Surgery has only a small part to play.

Children are almost always cured by having their tonsils and adenoids removed. In the past, adults were sometimes subjected to surgery of the nasal septum or of the soft palate and the uvula, which hangs down at the back of the throat. But the latter operation can have some serious side effects such as allowing food to enter the windpipe as well as post-operative pain.

Many other forms of surgery have been tried over the years but without success.

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